[Past and present asthma mortality: towards a shift in the secular trend?]

Abstract

In recent years disconcerting observations have been published concerning changes in mortality from asthma in France and other countries. These conclusions are difficult to assess due to uncertainty regarding the underlying asthma mortality trends. We have attempted to address this question by constituting a statistical series of asthma deaths from 1925 to 1989. The 1925 to 1989 mortality trend is clearly decreasing. This decrease follows the same rhythm as the general mortality decline, since the proportion of asthma in total deaths remained between 3 to 4/1000. Three periods are emphasized: from 1925 to 1965 where the decreasing trend is interrupted by an important crisis in mortality, from 1965 to 1980 where the decrease is regular, and the last period since 1980 with an important crisis in 1985 and 1986; crisis applying to all genders and ages. The latest trend is uncertain. Careful epidemiologic surveillance will decide between a change in the secular trend or a transitory crisis and thus determine the cause(s). An effect due to the reinclusion by ICD 9 of a fluctuating component in asthma mortality cannot be excluded.